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Canada got the last hurrah at the Celebration of Light Saturday evening, closing the three-night event with a winning display. Canada was declared the winner of the event, with Brazil and China finishing second and third, respectively.

The confluence of a major medical breakthrough and a largely untreated pool of hepatitis C carriers has patients and doctors clamouring for treatments that drug companies are promoting at sky-high prices.

Wiping out the viral disease that can cause cirrhosis of the liver or liver cancer is within reach, but for now only people with gold-plated private medical insurance are receiving the treatment.

The rate of infection in B.C. is higher than the rest of Canada, so the consequence of the provincial drug plan Pharmacare deciding to fund direct-acting anti-viral medication is potentially huge. About 73,000 B.C. residents have hepatitis C. It is a blood-borne disease spread by intravenous drug use, tainted blood transfusions and improperly sterilized medical equipment.

There are two main groups of hepatitis C patients: almost all new transmissions of the virus are among active IV drug users; another group with higher than average infection rates are baby boomers and immigrants exposed to unsafe hospital and dental practises before the virus was officially identified in 1989.

“The problem here in B.C. is that we just don’t treat enough people,” says Daryl Luster, president of the patients’ group, Pacific Hepatitis C Network.

“The only people being treated are those with really great insurance.”

Two direct-acting anti-viral medications have received approval from Health Canada within the last year — Sovaldi from California-based Gilead Sciences Inc. and Galexos from the multinational giant Johnson & Johnson — with a third unnamed medication from U.S.-based AbbVie accepted for review.

Liver specialists are using these drugs alone or in combination for various types of hepatitis C and the scientific consensus is that they offer cure rates above 90 per cent.

In Canada, the cost varies from around $35,000 to $55,000 per patient for a single 12-week round of treatment.

“These are fantastic drugs” says Dr. Eric Yoshida, a liver specialist who also teaches at the University of British Columbia’s faculty of medicine. “They specifically target the reproductive machinery of the hepatitis virus.”

They mark a dramatic advancement on lengthier and side-effect prone treatments that include interferon injections and a cocktail of pills.

The first of these oral-only medications will reach Canada’s national drug-funding review committee in July, and provinces will later make their own decisions about what to cover, no doubt in the face of fierce lobbying from patient groups, many of which receive operating funds from the pharmaceutical industry.

Insurers in the U.S. have been stunned by the number of people who have already taken Sovaldi, winner of the race to market. Sovaldi racked up more than $2 billion US in sales during its first four months on the U.S. market, shattering previous pharmaceutical records. A run of Sovaldi costs $84,000 in the U.S., significantly more than the Canadian price of $55,000.

“Sovaldi has shown tremendous results, and it’s the kind of medical innovation we need to sustain. Unfortunately, the drug’s maker has priced it at an astronomical level that is not sustainable for consumers, innovation or society,” the America’s Health Insurance Plans said on its official blog earlier this month.

In Egypt, a 12-week course of Sovaldi costs $900. That country has the world’s highest rate of hepatitis C because poorly sterilized needles were used in a 1970s government inoculation program.

Canada will have to bargain hard with drug suppliers to avoid U.S.-style prices here, says Alan Cassels, an expert in drug policy at the University of Victoria.

“The first question is, how can they justify the price?” he said. “The prices are arbitrary, and set at what they can extract from the consumer.”

“The second question is: how many people will you have to treat to avoid one liver transplant?”

The Canadian Liver Foundation says a liver transplant typically costs the health care system about $100,000, higher if there are complications.

Finding out who would benefit most from the treatment is important, agrees Dr. Mel Krajden who oversees hepatitis prevention at the BC Centre for Disease Control. People with hepatitis C are much more likely to develop a liver disease than the rest of the population, but only about 15 to 30 per cent of hepatitis C carriers will do so, he said.

Many people never know they have been infected with hepatitis C because they have no symptoms or only vague maladies such as fatigue. Others find out they have it after their livers are already badly compromised. Abnormal liver function is usually first detected by a blood test; liver biopsies and scans can then determine the extent of the damage.

“What we don’t know is, does everybody need treatment?” said Krajden. “We have to come to grips with this because as a society we can’t afford to treat everyone.”

“HIV had the same phenomenon: the companies initially tried to make the highest profit. You have pharma which is interested in making money — but without pharma we wouldn’t have the cure.”

Even more companies are expected to come out with similarly effective medications in the near future and Luster of the Pacific Hepatitis C Network wants as many as possible approved in Canada to create competition.

In the meantime, he advises patients to seek out clinical trials of these new medications in Vancouver — funded by pharmaceutical companies — for a cure. That’s what he did successfully in 2010 after discovering the disease at age 55. The businessman from Richmond says he has no idea how he contracted hepatitis C, has never injected drugs and was diagnosed by accident after years of fatigue and nausea.

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